ABSTRACT
A 74-year-old hemodialysis patient with a history of an atrial septum defect closure, coronary bypass surgery, and a St. Jude aortic prosthetic valve was diagnosed with pneumonia and volume overload. Blood cultures were positive for Listeria monocytogenes, and amoxicillin was given for 2 weeks. Immediately after discontinuation of amoxicillin, fever relapsed. Transthoracic and transesophageal echocardiography showed no sign of endocarditis. Given the fever relapse and 3 positive minor Duke criteria, an 18F-FDG PET-CT scan (18F-fluorodeoxyglucose-positron emission tomography-computed tomography) scan was performed. This scan showed activity at the aortic root, proximal ascending aorta, and inferior wall of the heart, making Listeria monocytogenes endocarditis a likely explanation. Amoxicillin was given for 6 weeks with good clinical result. Diagnosing a life-threatening Listeria monocytogenes endocarditis can be challenging and an 18F-FDG PET-CT scan can be helpful.
ABSTRACT
OBJECTIVE: Little is known about prevalence of persistent vegetative state/unresponsive wakefulness syndrome and comparisons between countries. The aim of this column was to explore reasons for the comparable count of patients in vegetative state found in prevalence studies in nursing homes in 1 European country (Netherlands) compared with a single European city (Vienna, Austria). DESIGN: The column is based on a literature review of vegetative state in The Netherlands and Vienna in the period 2007-2008, in the context of professional interactions with families and physicians of patients in vegetative state. In addition, in both countries, families and physicians were interviewed to illustrate views. RESULTS: Comparable between the 2 settings are the population characteristics and the definition of, and criteria, for vegetative state. A difference can be found in the development of authoritative policy guidelines in the Netherlands, after public debates and jurisdiction, which did not exist in Vienna at the time. There also seem to be different societal values concerning rehabilitation and end-of-life decisions for patients in vegetative state. DISCUSSION: The most important explanation for the vegetative state prevalence differences between the Netherlands and Vienna can be found in the different societal values about patients in vegetative state and their treatment and rehabilitation. In the Netherlands, life prolonging medical treatment, including artificial nutrition and hydration, is considered futile and can be withdrawn if there is no prospect of recovery. In Vienna, however, patients in vegetative state are regarded as severely disabled and in need of long-term rehabilitation and social reintegration. There is no end-of-life discussion in this context.
